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[目的]探讨人细小病毒B19(B19)感染导致类风湿性关节炎(RA)的机理及免疫因素在其中的作用。[方法]随机抽取住院RA患者56例为病例组,外伤和骨关节炎55例作为对照组,应用聚合酶链反应(PCR)对其血液和关节液标本进行B19-DNA检测。同时对另外31例RA病例和11例对照的骨髓标本也进行B19-DNA检测。应用酶联免疫吸附测定法(ELISA)对上述血液标本进行B19-VP2-IgM检测以及血清中的炎症细胞因子(CK)TNF-α,IL-1,IL-6,IL-8的检测。[结果]病例组血标本B19-DNA阳性19例(33.9%),关节液标本B19-DNA阳性20例(35.7%);B19-VP2-IgM阳性14例(25.0%)与对照组间差异均有统计学意义(血χ2=14.69,P﹤0.01,关节液χ2=14.69,P﹤0.01,B19-VP2-IgMχ2=10.272,P﹤0.05)。在56例RA中,12例B19-DNA、B19-VP2-IgM阳性,2例仅B19-VP2-IgM阳性,7例仅B19-DNA阳性,同时B19-DNA、B19-VP2-IgM阴性35例;一致率为83.9%(P﹥0.05)。RA患者31例骨髓标本中16例B19-DNA阳性,阳性率为51.6%,与对照组(9.1%)比较差异有统计学意义(χ2=4.284,P﹤0.05)。RA患者骨髓标本B19-DNA阳性率高于血清(χ2=4.313,P﹤0.05)和关节液(χ2=4.313,P﹤0.05)。病例组CK水平高于对照组,两组间差异具有统计学意义。病例组B19-DNA阳性和B19-DNA阴性间上述细胞因子水平的比较差异无统计学意义。[结论]RA患者有较高的B19病毒感染率,B19病毒与RA密切相关,但B19并非是导致RA的唯一因素,作为一种诱发刺激因素,与其他致病因素协同作用,导致部分患者免疫功能紊乱,从而导致RA的发生。
[Objective] To investigate the mechanism and immune function of human parvovirus B19 (B19) infection in causing rheumatoid arthritis (RA). [Methods] 56 cases of RA patients were randomly selected as the case group, 55 cases of traumatic and osteoarthritis as control group. The B19-DNA of blood and synovial fluid samples were detected by polymerase chain reaction (PCR). At the same time, B19-DNA was also detected in another 31 cases of RA and 11 cases of control bone marrow samples. The blood samples were tested for B19-VP2-IgM and the levels of TNF-α, IL-1, IL-6 and IL-8 in serum by enzyme linked immunosorbent assay (ELISA) [Results] The positive rate of B19-DNA in 19 cases (33.9%) and 20 (35.7%) B19-DNA in the synovial fluid specimens were all significantly higher in case group than those in control group There was statistical significance (blood χ2 = 14.69, P <0.01, synovial fluid χ2 = 14.69, P <0.01, B19-VP2-IgMχ2 = 10.272, P <0.05). In 56 cases of RA, 12 cases were positive for B19-DNA and B19-VP2-IgM, 2 cases were positive for B19-VP2-IgM, 7 cases were positive for B19-DNA only, while 35 cases were negative for B19-DNA and B19-VP2- ; The agreement rate was 83.9% (P> 0.05). The positive rate of B19-DNA in 16 of 31 bone marrow specimens from RA patients was 51.6%, which was significantly different from the control group (9.1%) (χ2 = 4.284, P <0.05). The positive rate of B19-DNA in bone marrow specimens from patients with RA was higher than that from serum (χ2 = 4.313, P <0.05) and synovial fluid (χ2 = 4.313, P <0.05). CK level in case group was higher than that in control group, the difference between the two groups was statistically significant. There was no significant difference in the level of cytokines between B19-DNA positive and B19-DNA negative in case group. [Conclusion] The infection rate of B19 virus in RA patients is high, and B19 virus is closely related to RA. However, B19 is not the only factor leading to RA. As a stimulating factor, it synergizes with other pathogenic factors and causes some patients’ immunity Dysfunction, leading to the occurrence of RA.